Archive for September 2016

Former Conservative health minister Dr Dan Poulter is calling on Theresa May and MPs to act to save the NHS and the social care system from collapse.

Dr Poulter, who stepped down from the Department of Health last year and now works both as an MP and as a part-time NHS doctor, said his experience inside hospitals had convinced him that radical, long-term funding solutions for the health and care sectors are “urgently required”.

Quoting from an article in the Observer, he says: “On the hospital wards I often see people who are medically fit to go home, but who are forced to stay in hospital because of difficulties arranging their social care package or because of a lack of appropriate housing. Good healthcare cannot be delivered without properly funded social care.”

Have we heard this a million times before?

He adds: “A long-term plan to ensure a properly funded and sustainable health and social care system is urgently required, and I believe a health and care tax – perhaps introduced through raising national insurance – offers one of the simplest ways forward.”

Dr Poulter’s appeal comes amid growing frustration over the government’s approach to social care and how to fund it.

I note that in the Conservative manifesto last year, former prime minister David Cameron promised to introduce a cap of £72,000 on the care costs for each individual, after which the state would pay. But soon after polling day, he delayed the scheme to 2020 because money was not available.

One of the key players in steering the plan for a cap through parliament, Dr Poulter said that with public finances unlikely to improve, the much-vaunted policy had little chance of being implemented.

Why am I not surprised!

Quote: “Given that the introduction of a cap was considered unaffordable a year ago, and that the costs of social care continue to increase, there is now little prospect of the cap being introduced at all.”

He is now suggesting a special tax that will guarantee an income stream, rather than policies like the cap which are entirely dependent on the economic climate of the moment.

The call has has been seized upon by the King’s Fund think-tank which is asking for a “frank and open debate” on how to fund health and social care on a sustainable basis into the future.

No doubt Dr Poulton’s call and the King’s Fund response will be another challenge for Mrs May to meet after the leaked story on how NHS bosses were drawing up plans for hospital closures, cutbacks and radical changes to the way healthcare is delivered in an attempt to meet spiralling demand and plug the hole in its finances.

“The government needs to get to grips with the scale of the social care crisis. The reality is that at least a million people aren’t getting the basic care they need. One million hospital days were lost to delayed discharge in 2015, costing the NHS £2.4bn, and it’s estimated that the money spent by the NHS on excess bed days due to people awaiting homecare could fund 5.2 million hours of homecare. The latest figures show that at least £1bn is needed for social care this year – just to keep things as they are,” the doctor says.

Last year’s Conservative manifesto pledged an extra £8bn a year for the NHS by the end of this parliament, as demanded by the NHS chief executive, Simon Stevens, in his 2014 “five-year forward view”. But Stevens made clear that was the minimum money required, and radical reforms to the way healthcare is delivered would also be necessary to make the NHS hit its budgets.

Like no time before we need a leader to champion our cause. Mrs May, would you step up the plate?

Alan Long is executive director of Mears Group PLC and in the last few months, has taken the “agonising” decisions to hand back a number of homecare contracts to local authorities, especially in the north of England.

In a Guardian article he explains why he felt it necessary to take such action.

The sense of desperation and frustration is tangible. It’s an argument you’ll have heard before . . . currently being considered by our providers in Birmingham and other Midlands areas.

This is what Mr Long writes: “As painful as this has been for the people we have been providing care for – and for our care workers – we hope others will follow our lead and help to end commissioning practices that should have no place in 21st-century Britain.

“Exiting contracts in this way is always the last resort and follows many months of trying to develop a different solution with a commissioner. But, ultimately, it may be the only means to drive the essential change in services that are life-critical to our most vulnerable citizens.

“We are not happy with the disruption this creates, but we feel that we have to take a stand to lead positive change in the absence of leadership from elsewhere.

“The contracts we have exited are those where simple mathematics shows that the charge rate a council wants to pay will result in a provider either not meeting the requirements of the “national living wage” for care staff, or not delivering the service needed by the user.

“In the homecare world, generally, councils only pay for “contact time” – the time a care worker spends with a service user. They don’t pay for the time it takes the worker to get to the property or move on to the next. They don’t pay for any of the time the worker must spend on training, or for the worker’s “on-costs” to ensure they are looked after if they fall sick. Nor do they help pay into their pensions.

“In recent years, councils have also shortened call lengths in order to cut costs, and many people have lost a service altogether.”

Could this be written about any area of the West Midlands and especially in Birmingham where most of our members have already withdrawn their services from the City? I think so.

Business are getting progressively militant it seems as they are driven into impossible corners. I started this post thinking of using just a few comments, but the article makes compelling reading without embellishes from myself.

Mr Long continues: “The “national living wage” is, of course, the bare minimum we need to pay – and rightly so. Being a care worker is an increasingly skilled job, requiring staff who can provide highly intimate personal care as well as support with medication. It is not for the faint-hearted and requires talent, dedication and strength.

“It is no surprise then that there is a national shortage of care staff. In the last 12 months alone, a lack of homecare capacity in the community has caused delayed discharges from hospitals to increase by 40 per cent.

“At a time when the NHS is creaking at the seams, there is an inherent short-sightedness in a system that focuses on cutting support for individuals, reducing call lengths and keeping charge rates for providers below sustainable levels.

“Unfortunately, many care providers still choose to accept very low charge rates from councils. This could be due to a lack of understanding of the minimum wage law, but is often simply caused by local businesses feeling they have no choice but to accept the terms offered, or risk going under. These businesses are often small and rely on a single contract just to exist.

“I have huge sympathy for councils on this issue, especially as many have been forced to cut other services to protect social care budgets. However, there is no excuse for setting charge rates that will almost certainly lead to breaches of the minimum wage or poor service.

“The last few governments have talked about reconsidering how we, as a society, fund social care – but nothing material has happened. Ultimately, this means we are failing to examine how we want to look after older and vulnerable people who need our support. All demographics point to an increasingly elderly population over the next 10 to 20 years, many of whom will be living with multiple long-term conditions. Surely it is a measure of a good society that we provide proper care for those people, at a time when they need it most?”

Mr Long suggests: “If we had given even 1 per cent of the time spent discussing Brexit on trying to reach a solution to the social care crisis, we might have one by now” and majors on the importance of having a sustainable care system.

Mears Group PLC is a major care industry player. Sadly, many of my members are independent, small businesses that do not have the wherewithal to join such a protest.

I fear for our future if we fail to move the hand of this government. I hope sincerely that Mrs May, a self-confessed champion of fairness, gets the message the care sector is sending out and administers fairly over our current needs.

Creative solutions – a sound bite of the 80s – is alive and ticking with two northern employers coming together to help tackle the care industry skills shortage.

TyneMet College and Age UK North Tyneside’s EveryDay Home Care service have launched a new training programme to upskill workers in the healthcare sector and develop the next generation of industry talent.

I love it!

Health and social care staff from EveryDay Home Care’s workforce and Age UK North Tyneside Wellbeing Services will undergo a structured training programme that covers a range of disciplines including health and safety, medication awareness, customer service, food safety, nutrition and first aid. The employees will study for a health and social care apprenticeship, which will combine on-the-job work experience with classroom learning at TyneMet.

The partnership with TyneMet comes as demand for homecare services is on the rise and providers are struggling to recruit suitably skilled staff.

Alma Caldwell, group chief executive at Age UK North Tyneside and EveryDay Home Care, was reported in the media as saying: “We recognise the importance of increasing the skills base of our workforce, particularly as there is a shortage of suitably qualified workers in our industry.

“That’s why we’ve teamed up with TyneMet College to upskill our current workforce and provide an opportunity for other aspiring care staff to make their way in the sector.”

What can I say? Well, surprisingly quite a bit. . .

All care staff have to go through a structured training programme and many newcomers are signed up to apprenticeship schemes.

My West Midlands Care Association has always worked with local authorities, which have helped us to ensure that we get the right quality training and that it is easyily accessible when needed.

This year we are pushing boundaries and seeking to access training through other routes.

Our problem is that LAs are limited on what they can supply.

Currently we are working with ACCTV a company that produces interactive television training for care staff.

Previously, this has been the preserve of the Southern, well-funded areas, but we have now managed to secure a service with a realistic offer.

Our members will get a very good deal, be assured. Providers will get a taster and access to the dementia training program as September is Dementia Month.

I often blog about care providers and those employed by them, but I’d like to focus on another group of care workers who are equally important – the unpaid, part-timers who generally tend for family.

Looking after loved-ones with long-term conditions is something I have witnessed first hand – the compromises, the relentless selflessness and, critically, trying to juggle work and failing.

A new report from Age UK and Carers UK, Walking the Tightrope finds that more than ten hours caring per week can stretch to breaking point an older worker’s ability to remain in employment.

How do people manage? How did I mange? Somehow we do.

And those caring for even five hours a week tend to pass up opportunities for promotion or overtime with a knock-on effect on retirement income and savings, the report states.

‘Doing the right thing’ can undermine a worker’s financial security.

According to Age UK and Carers UK, the impact of caring is not felt equally across all socio-economic groups. Those in higher skilled occupations such as managerial or professional roles are often more likely to be able to make smaller reductions in their working hours than those in lower skilled groups.

But the lack of affordable quality social care options, inflexible employers and poor work practices can drive carers out of employment.

The guy we use for our media, John Nash, has for nearly 30 years juggled work and care for a wife with MS.

In the early years he worked for a compassionate company who embraced the problem with him, offered flexible working arrangements, time off for medical appointments and a sympathetic ear at director level.

But it changed suddenly and overnight he was, in his own words, “working for dispassionate strangers” who insisted all hospital appointments should be taken as whole days of holiday entitlement instead of lieu days owing and essentially flexibility just vaporised.

Overnight, he found himself within a regimented regime in which he could no longer fulfill the necessary care duties required of him. Redundancy was his only real option.

But as they say, for every cloud . . . he now runs his own consultancy and we have a great working relationship with him.

This example (John has given permission for publication) is the tip of the iceberg.

Older workers are most likely to be carers and to be providing more hours of care, and they face particular difficulties. The evidence indicates that the more hours of caring that are undertaken, the greater the impact on employment. This was so true of my experience and John’s too.

Excellent community care now enables John to continue to work – hardly surprising he is a champion of the direct funding model.

This new focus group research also highlights the profoundly negative psychological and emotional effects of withdrawing from the workplace.

It found many older carers experience increased feelings of loneliness and isolation following withdrawal from paid employment.

The Age UK/Carers UK report estimates that carers leaving employment is a substantial drain on the public purse; almost £1.3 billion a year when the costs of Carer’s Allowance and lost tax revenues on foregone incomes are taken into account.

Enabling people to successfully combine work with caring makes sense on an individual level, but the business case is also compelling.

The report estimates that supporting carers to stay in work could add an additional £5.3 billion a year to the economy.

Employers also lose out if talented and experienced employees leave work prematurely or are less able to do their job because of the demands on them.

What can be done to support those with caring responsibilities to remain in work? The Carers in Employment (CIE) project, funded by the Department of Health, Department of Work and Pensions and the Equalities Unit is looking for answers.

This two-year learning and development programme which started in April 2015 is managed by SCIE. Pilots are funded to explore the different ways this challenge can be met.

The CIE programme is being evaluated by the Institute of Employment Studies to ascertain what works to support carers to remain in or to return to work. It reports in 2017.

Can you imagine what changes could happen if our domcare providers could get the funding we believe they deserve. Better care? Yes. A chance for workplace involvement for volunteer carers? Yes.

Those people needing to go into a care home now face average fees of £30,000 a year as costs are rising ten times faster than pensioner incomes, writes The Telegraph consumer affairs editor Katie Morley.

A study by Prestige nursing, one of the UK’s biggest care agencies, found a “desperate and worsening” care crisis, with the annual cost of a care home room increasing by £1,536, or 5.2pc over the past year.

The article points out this is almost ten times more than the average £156 (1pc) income gains earned by pensioners over the same period.

Logically then, it suggests that paying for care without spending savings is becoming unaffordable even for the wealthiest pensioners.

Record low interest rates mean pensioners living off cash savings and buying guaranteed incomes in the form of annuities are struggling to generate monies which will not devalue as the price of goods and services gradually rises.

According to the Telegraph “the cost of the average single room in a full-time care home has pushed past £30,000 for the first time and is now £30,926, some £16,470 more than the average pensioner income of £14,456.

“It means pensioners are short by an average of £290 a week if they require residential care,” states the article.

Not surprisingly, the article adds: “London is the region with the most expensive care homes with the average cost now at £38,896 a year. It has overtaken the East of England as the most expensive as a result of experiencing the biggest annual rise in care costs of any UK region at 19pc.”

Before we go any further with this, I must add that every region has a different story to tell on the costs of care, often mirroring the social wealth of the area. We need to be careful how we take up this information and how it is used. For example, in the West Midlands it is more likely to be £24,000 per year, but still many try to provide quality care for less.

Nevertheless, the statistics in the media make compelling reading.

Ros Altmann, the former pensions minister, is quoted in the article, saying: “We have an increasingly desperate crisis in social care in this country. Nobody has set money aside to cover care needs for the increasing numbers of older people who cannot manage to look after themselves.”

Not a lot is made of why we are in this mess in Morley’s work, so I’ll add a nugget or two . . . Simple: Government no longer wants to fund social care in a fair and realistic way. To survive, care providers have to pass on costs. We’re not talking fat cat owners here, either; this is simple economics of survival.

In a separate article carried in the Guardian, Care England, lambasted the government for the crisis in the industry, accusing ministers of not having a strategy for older adult care and allowing local authorities to pay well below the cost of care for residents with state funding.

Martin Green, the chief executive of Care England, is quoted as saying: “I have great sympathy [for residents]. There is a dynamic in this called ageism. Why is it that when you get old and get a disease called dementia, you have to pay for it? I don’t know how in the age of the Equality Act you have older people having to pay for a service that younger people get for free.

“The government needs to have a proper approach to social care. Just pumping money into the NHS isn’t going to work. They need a clear approach, saying that this is what good social care costs. The government needs to show a bit of leadership, I am sick of them hiding behind localism and saying it is about local councils.”

Strong words., which I’d be willing to echo.

There will be those who will blame this current batch of figures on the greed of owners. Frankly, that’s rubbish. It’s just too easy to blame providers when all the facts are not present.

Some local authorities are paying just £330 a week for residents, the equivalent of less than £2 an hour.

Is that a fair rate for caring? Will that really cover hands-on care, laundry costs, food, lighting heating etc? Of course it won’t.

I recently stumbled on an article by Professor Peter Beresford in The Guardian and his comments are worth sharing in this blog.

He is emeritus professor of social policy at Brunel University London, professor of citizen participation at Essex University and co-chair of Shaping Our Lives.

He notes that 70 years on from the creation of the welfare state, social care is one of the biggest, most important and yet most neglected social policies.

“Now another new government needs to face up to the vital need for radical reform,” he adds.

Indeed, that’s so true, but also frustrating. We meet up with Ministers(as we did Paul Burstow in London) and suddenly they are gone – taking with them all the good work we have shared. Such is the political arena.

Prof Beresford’s message is clear – social care reform must come from the grassroots

I quote: “The spending cuts made in the name of austerity over the last six years have especially hit local authority social care.

“This in turn has particularly hurt the growing numbers of older and disabled people needing help, including mental health service users and people with learning difficulties. While the rhetoric surrounding social care has been all about integration, the tendency is still to treat it in isolation.”

This is someone who has a good handle on the underlying issues of funding – the root of nearly all social care ills – and the frustration we feel in trying to get joined-up thinking between the NHS and residential and domiciliary care.

Based on research and interviews by the screenwriter Paul Laverty, this movie tells the fictional story of Daniel Blake, a middle-aged widower in the North East who can’t work or get benefits after a near-fatal heart attack.

The internet trailer is challenging and introduced for me a broader horizon of how ‘The Cuts’ – ‘Austerity Measures’ – call it what you will – have impacted our lives and how food banks have become ‘normal’ in an increasing desensitised society.

I find myself questioning: What is social care coming to? How has this been allowed to happen and what more can I do to help educate those who handle the finances of Government and seem unable to find funds for us.

Prof Beresford is the author of a new participatory social policy text, All Our Welfare, and he highlighted that there really are alternatives, both to old-style welfare state and current “neoliberal privatising welfare” reform.

Interesting – mental note; must find out more!

David Brindle, the Guardian’s public service editor who chaired an All Our Welfare launch debate, referred to the post-war welfare state as a revolution and asked what kind of revolution we need now.

On the panel, John McDonnell, shadow chancellor, emphasised the importance of developing a new narrative for a new welfare state, reminding us that its founders not only created a new architecture, but also “won the argument” so that for years Conservative governments continued to protect it.

“It’s narrative that wins,” he said.

Significantly, this was a different kind of debate because it included the groups more often talked about than having a chance to do the talking. Representatives of Disabled People Against Cuts, Shaping Our Lives, other disabled people’s and service user organisations, campaigners and user researchers, were present in force as well as the policymakers, academics and researchers more often encountered.

Is this the way we must go?

Summing up, the professor writes: “This was one occasion that demonstrated that there are very different ideas out there about a future for social care and welfare, which come from the bottom up. But they tend to be hidden or devalued and we need foster these green shoots. This is perhaps already beginning to happen. . . .

“For me, the key question posed by writing All Our Welfare was, how should people look after each other in a 21st century society? The launch debate showed that there are already many answers in the making – if they are only allowed space to surface.”

Data protection is big business and maintaining compliance critical to avoid some very heavy fines.

Sensitive material included in DBS checks means that we are always diligent and the office kept secure. It may appear at times antisocial, but we don’t make the rules for this particular service we offer.

I must admit , however, I was surprised to see how steep fines can get, having read a piece in the Guardian about a county council being fined £100,000 after files containing highly sensitive personal details of more than 100 people were discovered in a disused building.

These social care files were found along with 45 bags of confidential waste at Town End House in Havant, Hampshire, by the new owners of the building after it was bought in August 2014.

The article stated the forgotten documents were found to contain “highly sensitive” information about adults and children in vulnerable circumstances, according to the Information Commissioner’s Office (ICO).

Officials at the ICO, which levied the fine on Hampshire county council, said there could have been “distressing consequences” if the data had ended up in the wrong hands.

The case appears complex and Hampshire county council is full of apologies. But the bottom line is that the council failed to look after the information for which it was responsible.

It serves as a timely reminder for all social care operators to be diligent over client files.

A single look at the local social care contracts and it is blatantly apparent the local authorities are twitchy about the Data Protection Act.

Data Protection is mentioned about 20 times and care just once or twice. . . it says it all.

The Information Commissioner’s Office is an independent official body whose role is to oversee all information legislation, including promoting access to official information and protecting personal information. All public and private organisations are legally obliged to protect any personal information they hold. Public bodies are also obliged to provide public access to official information.

Information legislation protects the human rights of people using services by ensuring information about individuals is:

Held only with consent

Held securely

Shared only on a ‘need to know’ basis

Accessible to them.

Confidentiality of information is a key part of maintaining dignity for those using health and social care services. The Data Protection Act (DPA) 1998 requires public bodies and their data controllers to comply with a range of data protection principles. There are some limits on confidentiality and these apply where there is a risk of harm to other people.

How should data protection affect the way we work?

It is even more important these days that documents, including emails, which contain personal data are:

Kept in an orderly fashion

Filed on registered electronic devices or in paper files as soon as practicable if they are to be retained;

Erased or destroyed when they are no longer required

You should not keep random collections of odd papers or old emails. If they need to be retained, they should be properly filed, as mentioned above

You should observe a clear desk policy

You should satisfy yourself that, if required, you could retrieve personal data for which you are responsible, to answer an enquiry from a data subject

All very legal, I know, but being sorry after the event doesn’t recover fines incurred.